This week is National Women’s Health Week, when women are specifically encouraged to make health a top priority. Women’s health is not just for women though – it is for all of us. And we should all be thankful that the women in our lives can now get the care they need thanks to the Affordable Care Act.

While moms like Robyn from Maryland and Diana from Illinois see the benefits of the law through the care their children get, the ACA works for all women across our lifespans. Thanks to the ACA, women like Jasmine and Joann from Indiana have access to preventive care such as mammograms, cervical cancer screenings, and tobacco use screening and interventions, without co-pays. Women trying to become pregnant have access to folic acid supplements, and women who are already pregnant can get screened for anemia without additional costs.

Starting on August 1, 2012, even more preventive services will be covered without co-pays. Daughters, like Katie from Illinois, will be able to get the comprehensive contraceptive care they need, without a co-pay and without the need for a medical diagnosis necessitating the prescription. They will also get screening and counseling for intimate partner violence and for sexually transmitted infections. Mothers-to-be will get screening for gestational diabetes, and new mothers will get the breastfeeding counseling and equipment they need without co-pays.

Full implementation of the ACA will also produce benefits for women. Take Sara from Wisconsin for example. Sarah has a blood clotting disorder, which could cause some insurance companies to deny her coverage. In 2014, this will become illegal, and Sara (and her family) will have the security in knowing that she will get the coverage she needs despite her pre-existing condition. Additionally, with full implementation of the law, Sara won’t have to worry about her insurance company charging her more money simply because she is a woman. In 2014, the ACA will make “gender rating” illegal in all 50 states.

With all of these benefits available to women now or available to women soon, it is important that the women in our lives know about this wonderful law. In honor of National Women’s Health Week, we at Raising Women’s Voices encourage you to talk to a woman you know and let her know about how the ACA is important to her. While you are together, take a picture and upload it to our MamaCare site. Tell us what benefit helps her the most and we’ll add it to our list of women helped by the ACA!

– Maryanne Tomazic, Raising Women’s Voices
Field Coordinator

Medical Homes: Local Focus, Better Health

As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates.

Community Catalyst and Georgetown University Health Policy Institute Center for Children and Families created the States of Innovation blog series to shine a spotlight on states that are trying to find a better way. We will highlight states that are pioneering new approaches to making Medicaid more sustainable without harming – and often by improving – care for the millions of vulnerable seniors, people with disabilities, children and low-income parents that rely on Medicaid.

For the most vulnerable populations, the health care system can be a maze leading not to better health, but to fragmented, costly, and inefficient care. By providing care management and creating a strong health care delivery infrastructure at the community level through a medical home program, North Carolina has made remarkable strides in improving quality and continuity of care and improved health for Medicaid beneficiaries while significantly reducing costs. For example, Community Care of North Carolina (CCNC), North Carolina’s medical home program created a statewide diabetes initiative that has improved the health of diabetes patients through improved glucose, blood pressure, and cholesterol control. Between 2000 and 2002, CCNC’s diabetes management program is estimated to have saved $2.1million.

Jasmine’s story helps illustrate what is happening behind those numbers. Jasmine is a North Carolina teen with diabetes. Her mom knew that as her daughter was entering middle school it was very important that she develop the skills to manage her illness. The American Diabetes Association hosts summer camps to provide kids with the skills and confidence they need to manage their own care. Jasmine’s mom didn’t have the money to send her to camp, but through CCNC, Jasmine’s nurse care manager identified scholarships that allowed Jasmine to attend the camp. By providing health care, facilitating access to community resources and empowering people to be active partners in their health care, North Carolina is improving health and quality of life while reducing costs for Jasmine’s family as well as thousands of other families like them.

To find out more about how CCNC works, including Jasmine’s story, you can view this video produced by the Ash Institute at Harvard’s Kennedy School of Government.

What is North Carolina Doing?
CCNC is a statewide public-private partnership that serves more than 1.2 million Medicaid beneficiaries as well as 70,000 low-income, uninsured residents. The state’s 100 counties are organized into 14 health networks, and within these health networks there are approximately 1,500 medical homes, 4,300 providers, and 600 care managers statewide.

Through CCNC’s extensive care management services, CCNC strives to improve health by ensuring access to care and community services. The CCNC care managers identify which enrolled members will benefit most from care management services, develop individualized care plans, provide health education and guidance on self-management of illness, facilitate positive relationships with and link patients to community services, plan and coordinate transitional care, and, when appropriate, make home and hospital visits. As Jasmine’s story illustrates, the work that the medical homes are doing extends well beyond the exam room.

CCNC has invested providers with ownership of the program, thereby engaging them in the process of health improvement and through partnerships with community resources and other community physicians. CCNC has created a strong network of support for the patients.

While support and a basic framework are provided at the state level, CCNC has found that health can be improved more concretely through the empowerment of patients and engagement of providers at the local level. CCNC has developed statewide health improvement initiatives, but they are flexible enough to meet the specific needs at the network or community level. Further, because the networks are better positioned than the state to understand the specific needs of their communities, networks are able to develop their own health initiatives to address regional health issues.

What Results Has North Carolina Achieved?
Despite the increasing enrollment of people with severe chronic physical and mental health concerns, CCNC has accomplished a variety of health improvements, including:

• • a dramatic decline in emergency room use and preventable hospital admissions
• • improvements in testing for and control of cholesterol, blood pressure, and diabetes that exceed national benchmarks
• • a significant decrease in asthma-related hospitalizations

CCNC has not only improved the quality of care and the health of patients, but has also provided significant savings to North Carolina and its taxpayers. Within its first years, CCNC was already achieving a savings of more than $100 million per year. An independent audit estimates that between 2007 and 2009 CCNC saved nearly $1.5 billion.

Continued expansion of CCNC programs may help the state to reap even more savings and provide higher quality care to more people. North Carolina is one of 15 states that received a planning grant from the Centers for Medicare & Medicaid Innovation to improve care for those who are enrolled in both Medicare and Medicaid (dual eligibles). As part of these integration efforts, the state is proposing to expand the CCNC medical home program to all eligible duals, which would provide medical home services for duals in all types of living situations, including nursing homes. Strong emphasis is placed on improving the engagement and input of beneficiaries and their caregivers.

What Can Other States Do?
With the passage of the Affordable Care Act (ACA), many states are looking to create or expand patient-centered medical homes or implement the ACA Health Homes Option. The Health Home Option in the ACA offers states an excellent opportunity to take advantage of increased federal matching funds to build a system, like North Carolina’s, that provides tangible improvements in health and wellbeing for Medicaid patients.

CCNC has been working for many years to develop the program into what it is today and other states cannot be expected to implement a program of this size or scope immediately. But states can start with smaller programs, and then invest those savings into expanding the program over time. CCNC’s efforts provide a sense of what can be achieved through a commitment to continuous program improvement.

-Siobhan Brown, Medicaid Policy Intern

This weekend not only marks a time where we will be celebrating Moms, but it marks the launch of a campaign celebrating everything the Affordable Care Act does for the health of mothers and children, “I Love MamaCare!”

Sadly, it is not uncommon to hear stories of moms who forgo preventive screenings or medical treatment, so their families can pay the bills and have food to put on the table. Thanks to the ACA, however, moms now have access to several of the preventive services they need to stay healthy, like pap smears and mammograms. Starting on August 1, 2012, moms will get access to even more services, like contraception and breastfeeding support, with no co-pay.

But the benefits of the Affordable Care Act go beyond just preventive care. It also gives protection against discriminatory health insurer practices. Take Tracy from Wisconsin, for example. Her son, Sami, has neurofibromatosis, which causes tumors to grow all over his body. He needs care that is a little more specialized than the care most 9 year olds need. The ACA now prevents insurance companies from dropping Sami’s coverage because he is sick, and from refusing to cover care once Tracy’s family hits a lifetime limit.

The ACA also provides moms the security in knowing their kids will stay covered, even as young adults. Diana from Illinois has a 24 year old daughter Katie who is currently in graduate school. One of her biggest worries is that Katie won’t have insurance or the ability to afford the care she needs. Thanks to the ACA, Katie can stay on her health insurance until she is 26, even after she graduates. (And luckily for mom, Katie won’t even need to live at home to get this coverage!)

With the ACA doing so much for Moms and our families, we’re celebrating it this weekend on Mother’s Day. In fact, we’re even coining our own name for the law. People can call it the Affordable Care Act and Obamacare – but at the end of the day, this law helps moms and families, so we at Raising Women’s Voices are calling it MamaCare.

Join Raising Women’s Voices online for our “I Love MamaCare!” campaign. Take a picture with your mother or child, and send us your story about how you or someone you know has been helped by MamaCare. We’ll share it on our Twitter and Tumblr, and make sure your voices are heard in support of MamaCare!

– Maryanne Tomazic, Raising Women’s Voices
Regional Coordinator 

Despite increasing awareness of mental health issues in children, one population that continues to be disproportionately affected is children in the foster care system. Studies suggest that between 50 to 60 percent of children in foster care have moderate to severe mental health problems. Additionally, foster youth who have aged out of the system have been found to suffer from post-traumatic stress disorder at a rate twice that of U.S. war veterans. To have such a significant percentage of this population suffering from mental health conditions means that there is a clear need for effective, accessible mental health care services for youth in the foster care system and those who exit the system.

Provisions in the Affordable Care Act aim to continue foster youth’s access to health services, including mental health services, beyond their exit from the foster care system. The Affordable Care Act expands Medicaid coverage to former foster youth up to age 26, thus providing continuity of care and access to health care services. This expansion will enable youth exiting the foster care system to continue to receive critical health care services to promote positive physical and mental health and wellbeing.

As health and child wellness advocates work with states to prepare for this expanded coverage, it’s important to have events like Children’s Mental Health Awareness week to remind policy makers and the public about how important these services are to children.

– Nicole Tambouret, Project Director and
Kyle Bogaert, Intern, New England Alliance for Children’s Health

Every now and then we come across a “wow, we couldn’t have said that better ourselves!” news or opinion piece on a topic we’ve been beating the drum about. That was our reaction this week when we read Ron Shinkman’s spot-on editorial, “5 much better ways to collect patient debt,” in response to an avalanche of recent media coverage exposing bad billing and debt collection behavior by hospitals.

Shinkman, writing for an audience of hospital executives, doesn’t mince words:

“It seems perfectly reasonable that highly educated professionals with advanced degrees in hospital or business administration want to be proactive about collecting unpaid bills….

But hospital patients didn’t buy a flat-screen television from you; most sought care because they had no other choice. And unlike the neighborhood Best Buy, there is likely not a single price for a single procedure posted anywhere in your institution.

In such an environment, dunning and then suing patients with low incomes and few resources to respond is extraordinarily short-sighted, if not mean-spirited.”

He then calls on hospitals to adopt five humane and commonsense proposals for hospitals around billing and debt collection (note: go to the editorial for full details on each proposal):

1. Don’t charge an uninsured patient more than 150 percent of Medicare. Period.
2. Start listing your prices. Immediately.
3. Don’t sue. Ever.
4. Don’t report to credit agencies. Ever.
5. Retrain and expand your social worker staff. Yesterday.

Well put. It’s refreshing to see a strong voice – and one with such keen insights into the hospital industry – calling for much-needed and smart reforms to hospital billing and debt collection practices so patients’ health and financial security isn’t jeopardized when they seek needed care.

– Kathy Melley, Communications Director

What you may not know is that nurses have quietly evolved over the past several decades to become an irreplaceable piece of our health care system architecture – they are a load bearing wall, not a support beam. Nurses are more likely to provide care in rural areas where there are primary care shortages. They can be instrumental in increasing access to basic care, connecting patients to needed physician services and other health care resources while saving the system money. They embody high quality, cost efficient care.

Some states recognize the growing importance of nurses and have passed laws expanding their scope of practice so that they may better support the needs of consumers and save taxpayer dollars. To learn more and to find out if your state has expanded the nurse practitioner’s scope of practice, visit Community Catalyst’s Medicaid report card.

The Affordable Care Act (ACA) also recognizes nurses as vital to our health care economy and harnesses their potential by investing in an expansion of the nurse workforce. The ACA provides funds to enhance the Nursing Student Loan Program (NLP) along with the Nursing Workforce Diversity Program. These programs allow students from disadvantaged backgrounds to access nursing educational opportunities and in return, work in disadvantaged areas, increasing patient access to care. The ACA also invests in the Nurse Education, Practice and Retention grant program, providing nurses with a stronger understanding of quality improvement.

And its not just the nurse specific provisions where nurses will positively affect our health care system –their role is evident throughout the ACA. One important program for nurse involvement is health homes or medical homes. This pilot, – which many states have taken up, emphasizes team care over individual care giving. The goal is for a team of providers to collaborate and better support patients with chronic illness than a single provider – and at lower cost with better results. Nurses are instrumental in this approach as they play an important role in guiding team medicine and freeing up physician resources for more complex patient demand. This is the direction of the future of medicine – using all of our providers’ talents to maximize efficiency and quality for patients.

This week as we celebrate National Nurses Week, take a moment to thank a nurse. Everyday nurses are advocating for our health, caring for our needs and leading us to a more sustainable health care system. As over 16 million new Medicaid eligible patients enter the health care system come 2014, we need nurses more than ever.

– Eva Marie Stahl, Policy Analyst

The truth is very little of this has any chance of becoming law in the near future. Most of what House Republicans have proposed is unacceptable to President Obama and Senate Democrats. One notable exception is that both the president and the House have proposed scaling back states’ use of provider taxes to fund Medicaid, making it a likely place negotiators will go as they try to find health care spending cuts in what promises to be a challenging lame duck session this November.

That session will mark the renewal in earnest of debate over federal policies on taxes and spending, and health care policy will be right at the center of that debate. A confluence of factors—including the immanent imposition of across the board spending cuts as part of the Budget Control Act (triggered by the failure of the “Super Committee” to reach a deal), expiring tax cuts, a need to increase the debt ceiling and the perennial problem with Medicare physician payment—will force a lame duck Congress to reach some agreement on spending cuts and/or revenue increases.

Of course, Congress is unlikely to resolve all of these thorny issues between Thanksgiving and Christmas, but even delaying the big decisions until 2013 comes with a price tag and will force Congress to come up with offsets. This is where provider taxes come back in. It’s one of the few areas identified by both parties as an acceptable place to go for health care savings, which effectively places a big target on the provision.

The larger danger is that in the context of negotiations during the lame duck, Congress will agree to an overall level of spending cuts that will not be possible to achieve without eviscerating federal health programs. To avoid this outcome, here is a modest suggestion of principles that should guide the White House and Congressional leaders as they consider how to move forward in the lame duck and beyond:

1. Revenue must be part of the solution. An approach to debt reduction that relies solely or even mainly on cuts will do more harm than good.
2. When it comes to health care, focus on system improvements and avoid benefit cuts to Medicare or cost shifting onto state Medicaid programs or other parts of the health care system.

By adopting these principles we can reduce the federal debt while still fulfilling the commitments of Medicare and Medicaid and the promise of the ACA. We should expect no less from our elected leaders of either party.

Response to news of consumer rebates suggests insurers are mathematically challenged
Thanks to the ACA, insurance policy holders (both individuals and employers) will receive an estimated $1.3 billion in premium rebates this summer. Not included in that total are the additional savings that many policy holders have enjoyed as insurers have worked to keep premiums down to avoid having to pay the rebates in the first place.

A disgruntled AHIP (the insurance industry trade group) issued a press statement cherry picking features of the ACA to argue that the benefit of the rebates would be offset by other features leading to higher costs. As AHIP tells it, the extra benefits that people will get courtesy of the ACA should only be viewed as an additional cost to consumers without an offsetting benefit (excuse me, but isn’t that why they call them “benefits”?). Conspicuously absent from AHIP’s accounting: any acknowledgment that the better coverage resulting from the ACA would reduce consumers’ out-of-pocket costs and, most significantly, that thanks to the ACA, substantial tax credits will be available to bring down premiums for millions of Americans. With this degree of fuzzy math it is no wonder that the industry gets the numbers wrong so often in their rate filings.

Meaning of Medicare Trustees Report, like beauty, is in the eyes of the beholder
And speaking of fuzzy math, when the Medicare Trustees released their annual report last week it provoked the usual claims that the sky is falling from those seeking to destroy Medicare in order to save it. Let’s get some perspective here. The Trustees have been forecasting the date when the Hospital Insurance Trust Fund would be exhausted for many years. Sometimes the estimated lifespan of the fund has been even less than the current projection of twelve years. Those dates have come and gone. Yet the fund has not run out of money and the program has not crashed and burned. It’s not going to crash and burn this time either. The truth is federal spending on Medicare can be reduced and the Medicare program can be preserved for beneficiaries today and tomorrow without slashing benefits or turning the program into a voucher system. We can do this by making sure that we are not overpaying for services, protecting the integrity of the program from fraud and payment errors (recent good news on this front), and reducing the amount we spend on expensive care that could be prevented or delivered more cost effectively. To paraphrase Mark Twain, reports of Medicare’s imminent demise are greatly exaggerated.

 – Michael Miller, Director of Strategic Policy

The House passed HB 4626 with a vote of 215 – 195. Here’s the rub – House Republicans proposed financing this bill by defunding the Prevention and Public Health Fund (Prevention Fund)—a direct attack on the Affordable Care Act (ACA), which authorized the fund. Senate and House Democrats agree that hiking interest rates on student loans is unacceptable, but have proposed a better way to finance the effort. They would close a tax loophole on certain corporations with incomes over $250,000.

The vote to pass HB 4626 did not come without a number of statements in support of upholding the Prevention Fund. Several Senate Democrats spoke out against defunding the Prevention Fund, and they were accompanied by President Obama who released a veto threat statement defending the fund. The President’s statement is a clear sign that he will not stand by and allow Congress to continue to chip away at funding to improve the nation’s health.

As we reported here, the most recent threat was when Congress decided to cut $5 billion from the Prevention Fund to help ward off scheduled cuts in Medicare physician pay. House Republicans have painted it as a “slush fund” as part of their strategy to dismantle the ACA. They claim their motivation is to address the deficit or cut spending. The irony is that full investment in the Prevention Fund would help to reduce long-term spending by preventing illness and promoting health.

So far, the Prevention Fund’s biggest investments are in two areas: increasing the size of the health care and public health workforce and implementing community-based health care interventions such as programs that aim to reduce obesity and tobacco use by addressing environmental factors. Washington Post reporter Sarah Kliff highlights state examples of these investments here. These investments are critical in light of the recent projection that we will be short 30,000 primary care physicians by 2015 in addition to staggering rates of preventable health conditions such as obesity. According to the Centers for Disease Control and Prevention, more than 33 percent of adults and 17 percent of children and adolescents (2-19 years old) are obese in the U.S. With rates such as these we cannot afford NOT to invest in health care workforce development and prevention.

The bill has now moved on for a vote in the Senate, where Democrats hold the majority. The Senate is proposing a different version that would finance the bill by closing tax loopholes. While reducing student loan interest rates is important, financing should not be taken from the Prevention Fund to meet this goal. We need to vigilantly protect the Prevention and Public Health Fund because it will help improve the health of all and restrain the growth of health costs in the long run.

– Dara Taylor, Regional Manager, State Consumer Health Advocacy Program, &
Aurelia De La Rosa Aceves, 2012 National Urban Fellow

When patients seek emergency medical treatment, they expect to speak to doctors and nurses—not debt collectors. But hundreds of documents released last week by the Minnesota attorney general reveal that at least one medical debt collector, Accretive Health, has been working on the front lines in hospitals, often demanding that patients pay before receiving medical treatment.

According to The New York Times, the documents show that the embedded debt collectors may appear to be hospital employees and may even discourage patients from seeking emergency care. They follow scripts, just like debt collectors on the telephone, only they speak to patients in person at a time when they have immediate medical needs.

In addition to its scrutinized work at Fairview Health Services in Minnesota, Accretive Health holds contracts for “revenue cycle operations” with Henry Ford Health System in Michigan, Intermountain Healthcare in Utah, and Catholic Health East, which runs hospitals in eleven states. All of these hospital systems are non-profit corporations, meaning that the Internal Revenue Service (IRS) allows them to operate tax-free in exchange for providing certain benefits to the communities they serve. The tax savings realized by non-profit hospitals aren’t peanuts—$ 4.3 billion in 2002 alone. Non-profit hospitals make up less than 2 percent of non-profit organizations, but they receive 41 percent of federal non-profit tax benefits.

Many non-profit hospitals meet their “community benefit” obligations by providing charity care, also known as “financial assistance,” which helps fill a gap in health coverage for many uninsured and underinsured Americans. But measuring and monitoring hospitals’ community benefit efforts has been a challenge. In fact, in 2005, the IRS noted the prevalence of abuse of the amorphous “community benefit” standard, saying it had difficulty distinguishing between non-profit and for-profit hospitals in their operations.

As Corey Davis of the National Health Law Program and Jessica Curtis and Anna Dunbar-Hester of Community Catalyst explain in their recent article in Clearinghouse Review, Congress responded to this abuse by including in the Patient Protection and Affordable Care Act amendments to sections of the tax code that govern non-profit hospitals. These changes protect low-income and self-pay patients through new billing and collection standards that non-profit hospitals must follow to maintain their tax-exempt status. Unlike some parts of the new health care law, these changes went into effect immediately. According to Section 9007(a) of the Patient Protection and Affordable Care Act, non-profit hospitals now must:

• • refrain from engaging in “extraordinary collection actions” unless and until they have made “reasonable efforts” to determine if a patient is eligible for financial assistance,
• • limit charges for emergency or other medically necessary care for patients qualifying for financial assistance to the lowest amount charged to insured patients,
• • refrain from applying “gross charges” to patients who qualify for financial assistance,
• • have a written policy to provide emergency medical care regardless of a patient’s ability to pay, and
• • have a written financial assistance policy describing eligibility criteria, whether free or discounted care is available to low-income patients, how the hospital calculates charges, how it will publicize financial assistance, and how patients can apply for financial assistance.

To monitor and enforce compliance with the new law, the IRS recently revised the Schedule H form that non-profit hospitals must file with their Form 990 tax returns. Schedule H, the vehicle for reporting community benefit activities, now includes questions reflecting the new requirements from the Patient Protection and Affordable Care Act.

But the IRS isn’t the only one paying attention to this issue. After the Minnesota attorney general’s report, a California Congressman asked for an investigation of Accretive Health to probe whether its practices violated other federal laws. Last week a North Carolina newspaper ran a weeklong series highlighting questions around hospital profits, and on Friday afternoon, NPR’s “All Things Considered” featured a story on non-profit hospitals’ “stinginess” with charity care.

Whether the new health care law will prevent scenes such as those described in The New York Times article from recurring in non-profit hospitals remains to be seen. Davis, Curtis and Dunbar-Hester note in their Clearinghouse Review article that the Treasury Department is developing regulations that should define exactly what constitutes an “extraordinary collection action” and will elaborate on other sections of the health care law that could curb such behavior. By anyone’s definition, embedding debt collectors among medical staff seems, at a minimum, “uncharitable.”

– Amanda Moore
Staff Attorney-Legal Editor
Sargent Shriver National Center on Poverty Law

This March we called on advocates across the country to participate in our Affordable Care Act Anniversary Challenge, a contest designed to celebrate the successes of health reform. The goal of the challenge was to use letters to the editor (LTE) to illustrate how the Affordable Care Act is benefiting people.

Well, the results are in, and the advocates hit it out of the park. Sixteen states participated for a total of 30 pieces of earned media, and this is in addition to all the other great coverage they received during anniversary events over the month of March. We were so impressed by the diversity of voices, from small business owners to mothers to faith leaders and young adults. Advocates raised the consumer voice at a critical time.

To give our advocates a Shout Out for all their great work, we’ll start in the Northeast and work our way westward. First up is New Hampshire, with New Hampshire Voices for Health and Children’s Alliance of New Hampshire placing great op-eds. In Massachusetts Health Care for All placed a LTE by a longtime pediatrician. Moving southward, New Jersey Citizen Action received an honorable mention for its guest blog posts and LTEs, plus a fantastic TV appearance. Down in the Mid-Atlantic region we had Maryland Health Care for All Coalition and Virginia Consumers for Healthcare with stellar opinion pieces.

Heading even further south, we meet the CONTEST WINNER, the Tennessee Health Care Campaign! With nine op-eds and LTEs, we were amazed by the breadth and depth of their entries. Some of our favorites were Larry Drain’s letter about how freedom from insurance isn’t really free and an op-ed from Richard Henighan, a primary care provider, who writes about caring for patients who are uninsured or underinsured. Also in the South, we had terrific contributions from the South Carolina Appleseed Legal Justice Center and Alabama Arise. Kentucky had a flurry of activity from both Kentucky Equal Justice Center and Kentucky Youth Advocates. And finally, Florida CHAIN had strong pieces about how the ACA benefits children and brings tax relief to small businesses.

Out in the Midwest, there were great entries from UHCAN Ohio, Take Action Minnesota, and Michigan Countdown to Coverage. In the Mountain West, Colorado Consumer Health Initiative’s innovative pairing of four consumer letters to the editor and a policy op-ed received an honorable mention. And finally on the West Coast, OSPIRG and Washington State Community Action Network round out the entries with great media hits.

Congratulations to all the state groups that participated and for all the work that you do to communicate the importance of the Affordable Care Act and quality, affordable health care for all!

– Lucy Cox-Chapman, Communications Manager